Provider Demographics
NPI:1790269165
Name:PIONEER APCO LLC
Entity Type:Organization
Organization Name:PIONEER APCO LLC
Other - Org Name:UPSTREAM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:336-430-8450
Mailing Address - Street 1:1100 REVOLUTION MILL DR STE 10
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5067
Mailing Address - Country:US
Mailing Address - Phone:336-285-7985
Mailing Address - Fax:336-617-0781
Practice Address - Street 1:1100 REVOLUTION MILL DR STE 10
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5067
Practice Address - Country:US
Practice Address - Phone:336-285-7985
Practice Address - Fax:336-617-0781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PIONEER APCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-20
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13839OtherPHARMACY PERMIT